阿尔伯塔卒中项目早期CT评分在超急性卒中CT灌注和非增强CT中的可靠性、可重复性及预后准确性
Reliability, Reproducibility and Prognostic Accuracy of the Alberta Stroke Program Early CT Score on CT Perfusion and Non-Contrast CT in Hyperacute Stroke.
作者信息
Naylor Jillian, Churilov Leonid, Chen Ziyuan, Koome Miriam, Rane Neil, Campbell Bruce C V
机构信息
Melbourne Brain Centre, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Parkville, VIC, Australia.
出版信息
Cerebrovasc Dis. 2017;44(3-4):195-202. doi: 10.1159/000479707. Epub 2017 Aug 16.
BACKGROUND
Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic change on non-contrast CT (NCCT). We hypothesised that assessing ASPECTS regions on CT Perfusion (CTP) rather than NCCT would improve inter-rater agreement and prognostic accuracy, particularly in patients presenting early after stroke onset.
METHODS
Ischemic stroke patients treated with intravenous alteplase from 2009 to 2014 at our institution were included in this study. Inter-rater agreement and prognostic accuracy of ASPECTS across modalities were analysed by the time between stroke onset and initial NCCT, dichotomized 1st quartile versus quartiles 2-4, referred to as epochs. ASPECTS was assessed by 2 independent raters, blinded to stroke onset time, with agreement determined by weighted kappa (κw). Prognostic accuracy for favourable outcome (modified Rankin Scale 0-2) was assessed using the receiver-operating characteristic analysis.
RESULTS
A total of 227 participants were included. There was significant time-by-CT modality interaction for ASPECTS, p < 0.0001. The inter-rater agreement of ASPECTS on NCCT significantly increased as onset to CT time increased (κw epoch 1 = 0.76 vs. κw epoch 2-4 = 0.89, p = 0.04), whereas agreement using CTP parameters was stable across epochs. Inter-rater agreement for CTP-ASPECTS was significantly higher than NCCT in early epoch: Tmax κw = 0.96, p = 0.002; cerebral blood volume (CBV) κw = 0.95, p = 0.003; cerebral blood flow (CBF) κw = 0.94, p = 0.006, with no differences in the later epochs. Prognostic accuracy of ASPECTS on NCCT in epoch 1 were (area under the ROC curves [AUC] = 0.52, 95% CI 0.48-0.56), CBV (AUC = 0.55, 95% CI 0.42-0.69, CBF (AUC = 0.58, 95% CI 0.46-0.71) and Tmax (AUC = 0.62, 95% CI 0.49-0.75), p = 0.46 between modalities.
CONCLUSIONS
CTP can improve reliability when assessing the extent of ischemic changes, particularly in patients imaged early after stroke onset.
背景
艾伯塔卒中项目早期CT评分（ASPECTS）用于评估非增强CT（NCCT）上的早期缺血性改变。我们假设，在CT灌注成像（CTP）上而非NCCT上评估ASPECTS区域，将提高评分者间的一致性和预后准确性，尤其是在卒中发作后早期就诊的患者中。
方法
本研究纳入了2009年至2014年在我院接受静脉注射阿替普酶治疗的缺血性卒中患者。根据卒中发作至首次NCCT的时间，将其分为第1四分位数与第2 - 4四分位数，即两个时期，分析不同检查方式下ASPECTS评分者间的一致性和预后准确性。ASPECTS由2名独立的评估者进行评估，评估者对卒中发作时间不知情，一致性通过加权kappa（κw）确定。使用受试者工作特征分析评估良好预后（改良Rankin量表0 - 2分）的预后准确性。
结果
共纳入227名参与者。ASPECTS存在显著的时间与CT检查方式的交互作用，p < 0.0001。随着卒中发作至CT检查时间的增加，NCCT上ASPECTS评分者间的一致性显著提高（κw时期1 = 0.76 vs. κw时期2 - 4 = 0.89，p = 0.04），而使用CTP参数的一致性在各时期保持稳定。在早期，CTP - ASPECTS评分者间的一致性显著高于NCCT：Tmax κw = 0.96，p = 0.002；脑血容量（CBV）κw = 0.95，p = 0.003；脑血流量（CBF）κw = 0.94，p = 0.006，后期各时期无差异。时期1中，NCCT上ASPECTS的预后准确性为（受试者工作特征曲线下面积[AUC] = 0.52，95%可信区间0.48 - 0.56），CBV（AUC =
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